Occupation · SOC 13-1031
Claims Adjusters, Examiners, and Investigators
Review settled claims to determine that payments and settlements are made in accordance with company practices and procedures. Confer with legal counsel on claims requiring litigation. May also settle insurance claims.
Median wage
$76,790
$47,810–$112,150
Projected growth
-5.1%
Declining
Annual openings
-1,820
per year
Employed (US)
305,020
Job Zone 4
Typical preparation
Considerable preparation
Stackable credential programs
34 mapped
Core skills
Reading ComprehensionCritical ThinkingActive ListeningSpeakingJudgment and Decision MakingWritingComplex Problem SolvingSocial PerceptivenessMonitoringCoordinationActive LearningService OrientationNegotiationTime ManagementSystems AnalysisSystems EvaluationPersuasionMathematicsManagement of Personnel ResourcesQuality Control AnalysisLearning StrategiesInstructingProgrammingManagement of Financial ResourcesOperations MonitoringTechnology DesignManagement of Material ResourcesTroubleshootingOperations AnalysisScienceOperation and ControlEquipment SelectionRepairingInstallationEquipment Maintenance
Knowledge areas
Customer and Personal ServiceEnglish LanguageAdministrativeMathematicsComputers and ElectronicsLaw and GovernmentAdministration and ManagementEconomics and AccountingEducation and TrainingPsychologyMedicine and DentistryCommunications and MediaTherapy and CounselingPersonnel and Human ResourcesTelecommunicationsPublic Safety and SecurityBuilding and ConstructionSales and MarketingProduction and ProcessingTransportationSociology and AnthropologyMechanicalBiologyGeographyForeign LanguageEngineering and TechnologyPhysicsPhilosophy and TheologyChemistryDesignHistory and ArcheologyFine ArtsFood Production
Technology & tools
4n6xprt Systems StiffCalcsADP softwareARSoftware WinSMACAgency Management Systems AMS 360Apple SafariAutoClaims Direct DirectLinkAutomatic Data Processing AutosourceAutomatic Data Processing Claims Manager & DispatchAutomatic Data Processing EstimatingAxonwave Fraud and Abuse Management SystemBCCORP Burkitt W5BCCORP W5 for AdjustersBill review softwareBramerhill ClaimsTechBridium Claims 3Brightwork Alyce Claims SystemsBusiness software applicationsCAD Zone InsuranceCCC EZNet electronic communications networkCCC GuidePost Decision SupportCCC Pathways Appraisal Quality SolutionCCC Pathways Image Management SolutionCCC TL2000 SolutionCGI INSideOUTCGI-AMS BureauLink EnterpriseCSC Automated Work Distributor AWDCSC ColossusCSC Fault EvaluatorCaptiva InputAccelCastek Insure3 ClaimsClaims processing administration and management softwareClear Technology TranzaxComputerized voice stress analyzer CVSA softwareCorporate Systems ClaimsProCovansys ClaimConnectDatanex ClaimTracDocument management system softwareFair Isaac Claims AdvisorFair Isaac SmartAdvisorFirst Notice Systems ClaimCapture
Representative tasks
Working with ComputersCommunicating with People Outside the OrganizationGetting InformationMaking Decisions and Solving ProblemsIdentifying Objects, Actions, and EventsCommunicating with Supervisors, Peers, or SubordinatesDocumenting/Recording InformationResolving Conflicts and Negotiating with OthersOrganizing, Planning, and Prioritizing WorkAnalyzing Data or InformationProcessing InformationEstablishing and Maintaining Interpersonal RelationshipsUpdating and Using Relevant KnowledgeEvaluating Information to Determine Compliance with StandardsInterpreting the Meaning of Information for OthersMonitoring Processes, Materials, or SurroundingsPerforming for or Working Directly with the PublicJudging the Qualities of Objects, Services, or PeopleEstimating the Quantifiable Characteristics of Products, Events, or InformationPerforming Administrative ActivitiesScheduling Work and ActivitiesDeveloping and Building TeamsAssisting and Caring for OthersThinking CreativelyDeveloping Objectives and StrategiesTraining and Teaching OthersMonitoring and Controlling ResourcesInspecting Equipment, Structures, or MaterialsCoordinating the Work and Activities of OthersProviding Consultation and Advice to OthersSelling or Influencing OthersCoaching and Developing OthersGuiding, Directing, and Motivating SubordinatesStaffing Organizational UnitsOperating Vehicles, Mechanized Devices, or EquipmentPerforming General Physical ActivitiesHandling and Moving ObjectsControlling Machines and ProcessesDrafting, Laying Out, and Specifying Technical Devices, Parts, and EquipmentRepairing and Maintaining Mechanical Equipment
Competency framework
Skill expectations by proficiency level.
emerging
Claims forms and supporting records — review and organize under direct supervision to identify applicable insurance coverage on straightforward property or liability cases.Policy language and coverage terms — interpret with guidance to determine whether a submitted claim falls within the scope of a standard insurance contract.Data entry and document management software — use to input claim details and maintain accurate electronic files within the company's ERP or document management system.Police reports and medical records — locate and compile under supervisor direction to support initial determination of liability extent.Claimant interviews — conduct introductory conversations by phone or written correspondence using prepared scripts to gather basic facts about a reported loss.Claims processing procedures — follow established company protocols to route and pay straightforward claims within assigned authority limits.Property damage estimates — review pre-prepared estimates using office suite software and flag discrepancies for senior adjuster review.Office suite and internet browser tools — use to research coverage precedents, retrieve policy documents, and draft routine claim correspondence.Basic mathematical calculations — apply to verify reserve amounts and initial settlement figures against documented losses on low-complexity claims.Reporting templates — populate with investigation findings and submit to supervisors for quality review at the conclusion of each assigned case.
developing
Insurance coverage determinations — analyze claims forms, policy endorsements, and exclusions independently to resolve coverage questions on moderately complex cases.Investigation data — synthesize information gathered from multiple sources, including medical records and physical inspections, to produce written findings and settlement recommendations.Claims settlements — negotiate and process payments within designated authority levels, applying company practices and regulatory requirements with reduced oversight.Liability assessments — evaluate police reports, medical treatment records, and billing documentation to calculate the extent of insurer obligation on personal injury claims.Property damage inspections — conduct on-site assessments of damaged structures or vehicles, creating or reviewing repair estimates using financial analysis or CAD-based estimating tools.Questionable claim indicators — identify through active listening and document analysis during claimant and agent interviews, escalating suspected fraud patterns appropriately.Claim reserve accuracy — monitor and adjust reserve levels throughout the life of a case to reflect emerging information and compliance with administrative guidelines.Negotiation conversations — lead settlement discussions with claimants, attorneys, and repair vendors, applying social perceptiveness to reach fair and prompt resolutions.Time management practices — prioritize a moderate caseload to meet statutory response deadlines and internal cycle-time targets across varied lines of business.Expert system and billing software — use to validate medical bills and fee schedules against industry databases, ensuring payments align with contractual and legal standards.
proficient
Complex multi-party liability claims — investigate, evaluate, and settle autonomously, applying advanced technical knowledge and human relations skills to reduce loss ratios across a high-volume caseload.Coverage disputes and denials — resolve non-routine coverage questions by synthesizing policy language, case law, and regulatory guidance, producing well-documented written rationales.Large-loss property damage — direct field investigations and oversee contractor estimates using CAD software and financial analysis tools, validating total replacement or repair costs on high-exposure cases.Fraud detection patterns — apply inductive and deductive reasoning to investigate inconsistencies across claim documents, recorded statements, and third-party data, recommending referral to special investigations units.Litigation management — collaborate with defense counsel, monitor case strategy, and authorize settlements up to authority limits on litigated claims involving significant financial exposure.Regulatory and legal compliance — ensure all claim-handling activities conform to state insurance codes, privacy regulations, and company administrative standards across all assigned territories.Stakeholder communications — negotiate effectively with claimants, public adjusters, medical providers, and legal representatives, leveraging oral expression and active listening to achieve equitable outcomes.Loss trend analysis — monitor claim patterns within a book of business using financial analysis software, identifying systemic issues and providing data-driven recommendations to underwriting and management.Training and guidance — mentor junior adjusters on investigation techniques, coverage analysis, and negotiation strategy during routine case reviews and joint field activities.Claims technology optimization — evaluate and fully utilize ERP, document management, and expert system platforms to streamline workflow and maintain audit-ready case documentation.
advanced
Claims department strategy — set organizational direction for investigation standards, authority matrices, and loss-control objectives aligned with enterprise financial targets and risk appetite.Authority guidelines and best practices — develop and publish company-wide claims-handling protocols, coverage interpretation manuals, and settlement authority frameworks for all lines of business.Catastrophe response programs — design and lead large-scale multi-adjuster deployments in response to natural disaster or mass-casualty events, coordinating resources across regions and vendors.Loss ratio performance — lead executive-level analysis of claim cost drivers, presenting recommendations to senior leadership on reserve adequacy, pricing feedback, and litigation strategy adjustments.Regulatory relationships — represent the organization in interactions with state insurance departments, legislative bodies, and industry associations to shape compliance obligations and claims standards.Workforce development — create and sponsor competency-based training curricula, licensing programs, and career development pathways for the full claims workforce pipeline.Technology investment decisions — evaluate and champion adoption of AI-assisted triage tools, advanced expert systems, and predictive analytics platforms to modernize claims operations at organizational scale.Cross-functional leadership — partner with actuarial, underwriting, legal, and finance executives to align claims operations with product design, pricing models, and corporate governance requirements.Vendor and partner ecosystem — negotiate and oversee strategic contracts with independent adjusting firms, medical management vendors, legal panels, and repair networks to optimize quality and cost.Organizational culture and ethics — model and institutionalize standards of integrity, attention to detail, and fair-dealing that define the company's claims brand and support long-term customer retention.
Also known as
72 alternate job titles map to this occupation.
Accident InvestigatorAdjusterAdjustment ClerkAuto Claims Adjuster (Automotive Claims Adjuster)Auto Damage Claims Adjuster (Automotive Damage Claims Adjuster)Benefit AuthorizerBodily Injury Claims AdjusterBodily Injury Claims ExaminerClaims Account SpecialistClaims AdjusterClaims AdjustorClaims AgentClaims AnalystClaims ApproverClaims AuditorClaims ConsultantClaims ExaminerClaims InspectorClaims InvestigatorClaims ProcessorClaims RepresentativeClaims Service AdjustorClaims Service SpecialistClaims SpecialistClerical AdjusterCommercial Insurance InspectorCompensation AdjusterCorporate Claims ExaminerDisability AnalystDisability ExaminerDisability SpecialistField Claims AdjusterField InvestigatorField Liability GeneralistField Property Claims AdjusterField Property Claims SpecialistFire AdjusterFire Claims AdjusterGeneral AdjusterHealth Claims Examiner